How I got caught in, and escaped from, the health care machine

Dr. Gaston Castillo holds an EKG readout for the camera during a telemedicine hookup with Dr. Ricardo Munoz at Childrens Hospital of Pittsburgh. (Keith Srakocic/AP Photo)

According to hospital rules, I was so sick I couldn't leave until a cardiologist saw me, but I wasn't sick enough to for the hospital to let me see a cardiologist.

Eat your heart out, Yossarian.

I found myself sucked into the American health care machine last week. It started simply enough: I freaked. I woke up at 4 a.m. with a most distressing, painful, take-your-breath-away pain in my upper back. This quickly escalated – as things are prone to do at 4 a.m. – into “is my arm numb also and why can't I get a good breath and I'm sweating and that's it I'm going to the hospital.”

As I've previously written, I have atrial fibrillation, which is 99.99 percent of the time more annoying than dangerous, but coupled with my congenital neurosis ... well, I'm pretty hyper-aware when it comes to my heart.

Jeff Edelstein

So yes. I went to the hospital. Probably overkill, but I'd rather be safe 1,000 times than sorry once.

I get there, I get whisked back to the ER, bing-bang-boom and ... the American health care machine goes full throttle. This is the good part of the machine. Zero to 60 in 3.2 seconds. EKG, blood drawn, listening to my heart, a dozen other prods and checks ... it was pretty impressive. Within minutes, it was clear I was OK for the moment. Within three hours, and after a few more tests and a CT scan, it was abundantly clear that not only was I OK for the moment, but that I was OK, period. I was alarmingly OK. Every single test came back 100 percent normal. My back pain was clearly, obviously, a muscle strain of some sort.

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And this is when I got sucked into the machine, right through the tailpipe.

One of the residents stopped by and told me I was going to be admitted for an overnight stay. This was around 8 a.m. I said, “No thanks.” Then a nurse told me the attending physician – who was not present in the hospital, and wouldn't be until around 5 p.m. – wanted a cardiologist to clear me, which is why I was being admitted. Then another resident stopped by and told me – good news! – the cardiologist was here. Then ...

Then, the cardiologist told the resident he wouldn't see me. Why? Because I'm a patient with a different cardiology group. And that group also did rounds in this hospital. So I had to wait for them. And no one from my cardiology group would come to see me until the next morning.

And that's why I was being admitted. Because A) the hospital wouldn't discharge me until I saw a cardiologist; B) the cardiologists in the hospital wouldn't see me because I wasn't their patient; and C) my cardiology group wouldn't come to the hospital until the next day.

IRONY ALERT: Once I realized what was happening, my heart to skipped a few beats for the first time that day. True.

(And before we continue down this Catch-22 path: According to the Agency for Healthcare Research and Quality, an average overnight stay in the hospital runs about $10,000. And I was told the only reason I'd need an overnight stay in the hospital is because I needed a cardiologist to see me. And the cardiologist in the hospital wouldn't see me ... and so on.)

I was frustrated. I decided to leave AMA, “against medical advice.” But the nurses cautioned me this could mess with the insurance claim. So I called my insurance carrier. They said it wouldn't affect the claim, unless it did. (I'm paraphrasing, but not kidding.) They told me it depended on the codes and the this and that and ... well, I'd hate to be that guy who doesn't pay a $10,000 (or more) hospital bill.

Next thing I did was hit the Internet, and found the hospital I was at had a patient advocate of sorts. I called her, she came down to see me, I explained the situation. She agreed with me, realized the ridiculous nature of the problem, and thought it was reasonable for a cardiologist, any cardiologist, to see me so I could get discharged. (For the record, the nurses agreed as well. And the doctors. And a janitor. And every single person I told, which numbered in the low dozens.)

The advocate made some calls. I made some calls. Hours passed.

We all played “what if” games. Like, “What if I lived in Chicago and was visiting here, would my Chicago cardiologist need to be flown in?” and “What if my heart leapt out of my chest and started twerking on the floor, then would the cardiologist see me, or would I have to wait until my cardiologist swung by the next morning?”

Eventually – and this is after a ridiculous amount of man-hours – one of the cardiologists in the hospital agreed to see me. Took him all of five minutes to give me the all-clear. (And then two hours later – again, not kidding – I was finally discharged. The attending still had to see me. The paperwork still had to processed.)

Now: You may be wondering why I'm not naming the hospital, not naming the cardiologists, not naming anyone. The answer is simple: This was not a localized incident. This is the way things are done. Basically, if you have a specialist and find yourself in a hospital, doctors in the same speciality will simply not see you unless they're in the same group. Part professional courtesy, part not wanting to be seen as poaching patients, part because – in some cases – it makes sense to have a specialist you've seen before see you again. But this case was not about that last bit, as “my” cardiologist, the one that would see me the next day, is someone I'd seen the grand total of twice before. But he's in the same group as the cardiologist I normally see.

And, to belabor the point, I wasn't sick. At all. Not even a little bit.

But I was going to have to wait. Doesn't matter the “wait' would be 30 hours and at who-knows-what cost.

I guess we'll just throw this in the “American Health Care is Great but Totally Broken, Kind of Like Lindsay Lohan” file. It's a big file.

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